Bilateral Non-Arteritic Anterior Ischemic Optic Neuropathy in a Patient with Autoimmune Thrombocytopenia

Killer, Hanspeter E.; Huber, Andreas; Portman, C; Forrer, A.

doi:10.1177/112067210001000216

Cited by 15 publications

(6 citation statements)

References 5 publications

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“…However ophthalmic involvement is exceptionally rare. [2] Hemorrhagic ophthalmic manifestations associated with ITP include vitreous hemorrhage associated with intracranial bleeding in a Terson type phenomenon,[3] hemorrhage within the optic tract,[4] nonarteritic anterior ischemic optic neuropathy[5] and subconjunctival hemorrhage. [6] Thrombocytopenia alone, even severe (a platelet count <50 000), is rarely sufficient to cause significant retinal hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous bilateral peripapillary, subhyaloid and vitreous hemorrhage with severe anemia secondary to idiopathic thrombocytopenic purpura

Majji

Bhatia

Mathai

2010

Indian J Ophthalmol

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A 42-year-old female presented to us with a complaint of sudden painless loss of vision in both eyes of three days duration. Visual acuity was 20/100 for distance in both eyes. Fundus examination showed bilateral peripapillary hemorrhages, with subhyaloid and vitreous hemorrhage in both eyes. Hematological investigations revealed hemoglobin (HB 7 gm %) and severe thrombocytopenia (12,000/ ul). She was referred to a hematologist where a diagnosis of idiopathic thrombocytopenic purpura (ITP) was made. She was treated for systemic condition with regular ophthalmic follow-up. Over the next nine months, retinal hemorrhages completely resolved and the patient regained her visual acuity. The purpose of this case report is to highlight the clinical presentation of severe anemia, which is different from previous reports and the role of an ophthalmologist in first detecting the Idiopathic thrombocytopenic purpura (ITP), which led to successful recovery.

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Section: Discussionmentioning

confidence: 99%

Spontaneous bilateral peripapillary, subhyaloid and vitreous hemorrhage with severe anemia secondary to idiopathic thrombocytopenic purpura

Majji

Bhatia

Mathai

2010

Indian J Ophthalmol

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“…We made the observations that the vast majority of these patients are PVD subjects and that the occlusions occur in most cases after major psychological stress [264,265] or, alternatively, are drug induced [266]. AION, however, can also be observed secondarily to other diseases (see ‘Secondary vascular dysregulation’) such as autoimmune diseases [267]. …”

Section: Pvd and Ophthalmic Diseasesmentioning

confidence: 99%

The primary vascular dysregulation syndrome: implications for eye diseases

2013

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Vascular dysregulation refers to the regulation of blood flow that is not adapted to the needs of the respective tissue. We distinguish primary vascular dysregulation (PVD, formerly called vasospastic syndrome) and secondary vascular dysregulation (SVD). Subjects with PVD tend to have cold extremities, low blood pressure, reduced feeling of thirst, altered drug sensitivity, increased pain sensitivity, prolonged sleep onset time, altered gene expression in the lymphocytes, signs of oxidative stress, slightly increased endothelin-1 plasma level, low body mass index and often diffuse and fluctuating visual field defects. Coldness, emotional or mechanical stress and starving can provoke symptoms. Virtually all organs, particularly the eye, can be involved. In subjects with PVD, retinal vessels are stiffer and more irregular, and both neurovascular coupling and autoregulation capacity are reduced while retinal venous pressure is often increased. Subjects with PVD have increased risk for normal-tension glaucoma, optic nerve compartment syndrome, central serous choroidopathy, Susac syndrome, retinal artery and vein occlusions and anterior ischaemic neuropathy without atherosclerosis. Further characteristics are their weaker blood–brain and blood-retinal barriers and the higher prevalence of optic disc haemorrhages and activated astrocytes. Subjects with PVD tend to suffer more often from tinnitus, muscle cramps, migraine with aura and silent myocardial ischaemic and are at greater risk for altitude sickness. While the main cause of vascular dysregulation is vascular endotheliopathy, dysfunction of the autonomic nervous system is also involved. In contrast, SVD occurs in the context of other diseases such as multiple sclerosis, retrobulbar neuritis, rheumatoid arthritis, fibromyalgia and giant cell arteritis. Taking into consideration the high prevalence of PVD in the population and potentially linked pathologies, in the current article, the authors provide recommendations on how to effectively promote the field in order to create innovative diagnostic tools to predict the pathology and develop more efficient treatment approaches tailored to the person.

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“…Subretinal and vitreous haemorrhage in ITP at presentation Goel, Arora, Jain and Ghosh [4][5][6][7]11 which may be associated with intracranial bleeding in a Terson type phenomenon, 8 haemorrhage within the optic tract 9 and non-arteritic anterior ischaemic optic neuropathy. 10 Our case was unique in that the initial presentation of the patient was due to decreased VA. Examination revealed bilateral intraocular haemorrhages with macular exudation in the right eye.…”

Section: Figure 2 (A) Fundus Photograph Of the Right Eye At One Montmentioning

confidence: 80%

“…Ophthalmic involvement in ITP is rare and initially manifesting with ocular features has been scarcely reported, with no large case series describing the spectrum of ocular findings in ITP. Haemorrhagic ophthalmic manifestations associated with ITP include subconjunctival haemorrhage, preretinal, intraretinal, subretinal and/or vitreous haemorrhage, which may be associated with intracranial bleeding in a Terson type phenomenon, haemorrhage within the optic tract and non‐arteritic anterior ischaemic optic neuropathy …”

Section: Discussionmentioning

confidence: 99%

Massive subretinal and vitreous haemorrhages at presentation in idiopathic thrombocytopenic purpura: report of a case and review of literature

Goel

Arora

Jain

et al. 2014

Clinical and Experimental Optometry

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A 21-year-old woman presented with acute decreased vision due to massive subretinal haemorrhage with macular exudation in the right eye and vitreous haemorrhage in the left eye. Haematological work-up revealed thrombocytopenia (platelets 14,000/ml) with anaemia (haemoglobin 6.3 gm/100 ml). A diagnosis of idiopathic thrombocytopenic purpura (ITP) was confirmed by a haematologist. Systemic therapy resulted in dramatic resolution of the fundus features with near complete restoration of visual acuity over three months. ITP can present with intraocular haemorrhages, especially if accompanied by anaemia. A high index of suspicion and appropriate systemic treatment can lead to a successful outcome.

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Bilateral Non-Arteritic Anterior Ischemic Optic Neuropathy in a Patient with Autoimmune Thrombocytopenia

Abstract: Bilateral non-arteritic anterior ischemic optic neuropathy can develop in the presence of a very low platelet count.

Cited by 15 publications

References 5 publications

Spontaneous bilateral peripapillary, subhyaloid and vitreous hemorrhage with severe anemia secondary to idiopathic thrombocytopenic purpura

Spontaneous bilateral peripapillary, subhyaloid and vitreous hemorrhage with severe anemia secondary to idiopathic thrombocytopenic purpura

The primary vascular dysregulation syndrome: implications for eye diseases

Massive subretinal and vitreous haemorrhages at presentation in idiopathic thrombocytopenic purpura: report of a case and review of literature

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